Cleft Lip Palate Pedo | Face | Mouth

Seminar on

CLEFT LIP AND
PALATE

CLEFT LIP:
Cleft lip is a birth defect that results in a
unilateral or bilateral opening in the
upper lip between the mouth and nose.

CLEFT PALATE:
Cleft
palate
is
a
birth
defect
characterized by an opening in the roof
of the mouth caused by a lack of tissue
development.

DEVELOPMENT OF CLEFT
(a) Cleft Lip : Various theories have
been given for its development.
- Failure of fusion between median
nasal process and maxillary process.
- Failure of mesodermal migration
between the two layered epithelial
membrane.
This
leads
to
a
breakdown and cleft formation.
- Rupture of cyst formed at the site of
fusion.

(b)

Cleft Palate : Various theories have
been given for its development.

- Alteration in intrinsic palatal shelf
force
- Failure of tongue to drop down
- Non fusion of shelves
- Failure of mesodermal migration
- Rupture of cyst formed at the site

ETIOLOGY
1. Genetic factors
2. Nutritional disturbances during
development
3. Physiologic, Emotional or traumatic stresses
during development
4. Defective
involved

vascular

supply

to

the

area

5. A mechanical disturbance where the size of
the tongue may prevent the union of parts
6. Various
environmental
factors
like
infections
(e.g. Rubella), exposure to radiation, drugs
like
thalidomide,
antiepileptic
durgs,

CLASSIFICATION
1. Morphological Classification
(a) By Davies and Ritchie (1922)
(b) By Veau (1931)
2. Embryological Classification
(a) By Kernahan & Stark (1958)
(b) By Spina (1974)

1.a Classification by Veau
Group-I

Cleft of the soft palate only

Group-II

Cleft of the hard and soft
till the incisive foramen.

palate

Group-III

Complete unilateral cleft of
soft palate,hard

the
palate,the
alveolar ridge and the lip on one
side

Group-IV
soft palate,
alveolar ridge

Complete cleft of the
hard palate, the
and lip on

2.a Classification by Kernahan and
Stark
Group-I Cleft of the primary palate
only
(i)
Unilateral (ii) Bilateral
(iii) Total
(iv)
Sub-total

Group-II Cleft of the secondary palate
only
(i) Total
(ii) Sub-total
(iii) Submucous

Group-III Cleft of the primary &
secondary palate
(i)
(ii)

Unilateral -Total, Sub-total
Median
- Total, Sub-total

2.b Classification by Spina
Group-I Pre-incisive foramen clefts
(i)
Unilateral (ii)
(iii) Median

Bilateral

Group-II Tran-incisive foramen clefts
(i)

Group-III
clefts
(i)
(ii)

Group-IV

Unilateral

(ii)

Bilateral

Post-incisive foramen
Total
Partial

Rare facial clefts

SYMBOLIC AND
COMPUTERGRAPHIC
PRESENTATION
By Kernahan (1971)
Modified by Ehlsaky & Millard
(Rt)

(Lt)

1,5 : Nasal floor 2,6 : Lip
3,7 : Alveolus
4,8 : Hard palate
anterior to
incisive foramen.
9,10: Hard palate
posterior to
incisive foramen
11 : Soft palate

NORMAL ANATOMY

(ACCORDING TO KERNAHAN AND STARK CLASSIFICATION)

GROUP 1 UNILATERAL

GROUP 1a UNILATERAL

GROUP 1a BILATERAL

(CONTD.)

GROUP II COMPLETE

GROUP III UNILATERAL

GROUP III BILATERAL

CLEFTS OF LIP

BILATERAL COMPLETE CLEFT PALATE

INCOMPLETE CLEFT PALATE

BILATERAL CLEFT LIP AND PALATE

UNILATERAL CLEFT LIP AND PALATE

INCIDENCE
(a)Among different races
 Whites
- One out of 800
 Blacks
- One out of 2000

Japanese or Indians - One out of 500
(b) Of different clefts
 Cleft lip alone
 Cleft palate alone
 Cleft lip and palate both

- 25%
25%
50%

(c) Males > Females (for combined cleft lip &
palate)
Females > Males (for cleft palate only)
(d) Unilateral defects > Bilateral defects
(e) Left sided defects > Right sided defects
(f)

Increase in parental age  increase risk of

CLINICAL FEATURES
(1) FACIAL DEFORMITY – NOSE TIP DEVIATED TO NORMAL
SIDE, ALA ON CLEFT SIDE FLARED, NOSTRIL
HORIZONTALLY ORIENTED, LIP DEFORMITY,
HYPOPLASTIC AND A COLLAPSED MAXILLA ON SIDE OF
THE CLEFT AND THE CLEFT PALATE .
- FOR BILATERAL CLEFTS
ADDITIONAL FEATURES LIKE PROTRUDED PREMAXILLA, SMALL PRO-LABIUM, ABSENT COLUMELLA
AND SHALLOW GINGIVOLABIAL SULCUS.
(2) INABILITY TO SUCK MOTHER’S MILK
(3) NASAL INTONATION FOR CLEFT PALATE
(4) NASAL REGURGITATION
(CONTD.)

(5) TOOTH DEFECTS – WHICH MAY BE








SUPER NUMERARY TEETH
CONGENITALLY MISSING TEETH
T- CINGULUM
PEG LATERALS
THICK CURVED HYPOPLASTIC INCISORS
NATAL TEETH
GERMINATION
DELAYED ERUPTION OF PERMANENT TEETH
HYPOPLASTIC INCISORS NEXT TO ALVEOLAR DEFECTS

(6) ASSOCIATED SYNDROMES – CLEFT LIP MAY BE
ASSOCIATED WITH FOLLOWING SYNDROMES






DOWN’S SYNDROME
WARDEN BURG’S SYNDROME
VANDERWOUDE’S SYNDROME
ORO-FACIAL DIGITAL SYNDROME
TREACHER COLLIN’S SYNDROME
PIERRE ROBIN’S SYNDROME
KLIPPEL FEIL’S SYNDROME

REFERENCES:
1. TEXTBOOK OF PEDODONTICS:
SHOBHA TANDON
2. DENTISTRY FOR CHILDHOOD AND
ADOLESCENT:
McDONALD, AVERY

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